Acyclovir - Renal Dosing

In the setting of rapidly improving or worsening renal function, calculations of CrCl are inaccurate. Dosing should be based on estimated renal function instead.

If improving renal function, actual CrCl is likely higher than calculated CrCl.

If worsening renal function, actual CrCl is likely lower than calculated CrCl.

CrCl >50 mL/min

800mg PO QID, or 5-10 mg/kg IV Q8h

CrCl 30-50 mL/min

800mg PO QID, or 5-10 mg/kg IV Q12h

CrCl 10-29 mL/min

800mg PO QID, or 5-10 mg/kg IV Q24h

CrCl <10 mL/min

200mg PO Q12h, or 2.5-5 mg/kg Q24h

200mg PO Q12h, or 2.5-5 mg/kg IV Q24h (doses given on HD days should be given after HD)

5-10 mg/kg PO/IV Q24h